Hands up who doesn’t have an opinion about the best way to help babies get to sleep? It’s been a hotly contested topic in recent years, at dinner parties and playgrounds across the land.

Behavioural sleep techniques have been shown to be effective at reducing sleep problems in infants and the associated maternal depression in the short- to medium-term (4–16 months’ post treatment) (Mindell, 2006).

Two main techniques are quite widely recommended:

“Controlled comforting”: where the parent responds to the cry of the baby at increasing time intervals, to allow the child to “self-settle”

“Camping out”: where the parent sits with the baby as they independently learn how to fall asleep; slowly removing themselves from the child’s room

However, the long-term safety and efficacy of these interventions has been challenged in recent publications (Blunden, 2011) which have suggested that there may be better ways to help children to sleep.

Thankfully, a team from Australia and the UK have recently published the results of a population-based cluster-randomised trial that assesses the long-term benefits and harms of behavioural infant sleep interventions.

Methods

The researchers recruited children from health centres in Australia. Mothers were asked to complete a screening questionnaire and some reported that their baby’s sleep had been a problem in the last 2 weeks. Children who had been born premature (<32 weeks gestation) were excluded from the study, as were families who had insufficient English to participate.

Conclusions

The authors concluded:

Behavioral sleep techniques did not cause long-lasting harms or beneﬁts to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.

So this important new RCT provides the evidence that parents need to confidently use “controlled comforting” and “camping out” techniques to help their children sleep. The long-term safety of these approaches have been proven by this research, but a number of unanswered questions remain.

Very few children were still suffering from sleep problems at the end of this trial. Were these new cases or were they the same children who had problems at the beginning?

Most of the children in the usual care group were also sleeping well by the end. How did they learn to sleep and what advice did their parents receive from elsewhere?

This research excluded children with learning disabilities or developmental problems, so it may well be that the results cannot be applied to these groups, or possibly to specific ethnic groups that weren’t studied here in detail. Further research is needed before all parents can confidently use these behavioural sleep techniques.

We elves are obviously delighted with the results of this RCT. We “camp out” in the woodland most weekends (come rain or shine) and the thought of discovering that there were long-term risks associated with this behaviour had filled us with a terrible dread. We look forward to reading more research that investigates this area.

André started the Mental Elf website in May 2011.
He has worked as an Information Scientist in Mental Health since the late nineties; initially at Oxford University's Centre for Evidence-Based Mental Health and since 2002 as the Managing Director of Minervation Ltd.
He loves blogging, social media and elves! He also has established interests in evidence-based healthcare, usability testing and web design.

I have been in contact with Dr Anna Price, the researcher who wrote the RCT featured in this blog. She has kindly answered some of the questions I asked and given me permission to use her responses on the site.

Very few children were still suffering from sleep problems at the end of this trial. Were these new cases or were they the same children who had problems at the beginning?

All children in the trial had sleep problems at 7 months; this was an eligibility criterion. The persistence of sleep problems in this group of children is described in a second paper, which showed that only 2% of children had persistent sleep problems at all time points from 4 months to 6 years; very few children had sleep problems that persisted from 2 years to 6 years; and 23% had no sleep problems at any time point from 4 months to 6 years.
(This second paper is included in the blog links above – Price, Sleep Medicine, 2012)

Most of the children in the usual care group were also sleeping well by the end. How did they learn to sleep and what advice did their parents receive from elsewhere?

All families (whether intervention or control) were free to access any other care in the community. This ranged from talking to family members or neighbors to staying at parenting centers. In terms of sleep problems resolving, we know that much of this would be due to maturation, as sleep problems become less common as children grow older.

This research excluded children with learning disabilities or developmental problems, so it may well be that the results cannot be applied to these groups, or possibly to specific ethnic groups that weren’t studied here in detail. Further research is needed before all parents can confidently use these behavioural sleep techniques.

Thanks+ to Anna for this really helpful addition to the blog. It’s great to see researchers who are keen to get involved with disseminating their publications to those who need it. These further explanations and links add real value.

If you’ve got any further questions or comments on this research, please feel free to ask them here.